Provider Demographics
NPI:1639104912
Name:SCHNEIDER, LAWRENCE BASILIDE (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:BASILIDE
Last Name:SCHNEIDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 850
Mailing Address - Street 2:
Mailing Address - City:ST FRANCISVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70775-0850
Mailing Address - Country:US
Mailing Address - Phone:225-635-3269
Mailing Address - Fax:225-635-0028
Practice Address - Street 1:10289 GOULD DR
Practice Address - Street 2:SUITE C
Practice Address - City:ST. FRANCISVILLE
Practice Address - State:LA
Practice Address - Zip Code:70775-0850
Practice Address - Country:US
Practice Address - Phone:225-635-3269
Practice Address - Fax:225-635-0028
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD012763207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1168521Medicaid
B65132Medicare UPIN
LA1168521Medicaid